結合中西醫理論探討新冠肺炎的病程進展及治療展望

Exploring the Progression and Treatment Prospects of Coronavirus Disease 2019 (COVID-19) with the Integration of Traditional Chinese and Western Medicine

嚴重特殊傳染性肺炎 Coronavirus disease 2019（COVID-19）是由一種新 型冠狀病毒 SARS-CoV-2 所引起的疾病，已成為世界各國目前迫切需要解決 的醫療問題。對於 COVID-19，整合中西醫的相關研究，運用中醫理論來進 行分析探討中醫藥所能扮演的角色是本篇文章的核心價值。 本文對於 COVID-19 的論述主要根據近期發表的研究文獻，從流行病 學、病毒學、臨床症狀和西醫治療概略說明，再進入中醫對此疾病的認識， 依照病程輕重結合衛氣營血的傳變推論病因病機，並運用現代醫學的研究成 果加強以上中醫的論述。衛分屬 COVID-19 發作初期的免疫反應；氣分屬正 邪相爭達免疫高峰期；營分屬血管內皮功能異常；血分屬凝血障礙造成血栓 或瀰漫性血管內凝血。 最後在文獻實證的基礎下，探討中醫治療用方，病程在輕、中症屬衛、 氣分，可選用銀翹散、桑菊飲或麻杏甘石湯，病程進入重危症屬營、血分， 治療以西醫為主、中醫為輔，可使用安宮牛黃丸、生脈散或犀角地黃湯。期 待中西醫學的合作，有助於提升新冠肺炎的治療效果及預後。

Coronavirus disease 2019 (COVID-19) is a disease caused by a new coronavirus SARS-CoV-2, and has become an urgent medical problem needed to be resolved all over the world. The core value of this article was to integrate relevant research on Traditional Chinese medicine (TCM) and Western medicine (WM), and analyzed as well as explored the role that TCM can play by the theory of TCM. The thematic discussion about COVID-19 was mainly based on the recently published research literature. The article started from the general description of epidemiology, virology, clinical symptoms and WM treatment. Then, we discussed the viewpoint of TCM on COVID-19 and inferred the etiology and pathogenesis according to the severity of the progress of COVID-19 and the transmission of Wei, Qi, Ying, and Xue. In addition, we took advantage of modern medical research to strengthen the above paragraph. We described Wei as part of the immune response in the early stage, Qi as part of struggling between the vital energy and the pathogenic factor to reach the peak of immunity, Ying as part of vascular endothelial dysfunction and Xue as part of blood coagulation disorder such as thrombosis or diffuse intravascular coagulation (DIC). Finally, on the basis of evidence-based literature, we discussed the prescriptions of TCM. The mild and moderate stages of the disease could be defined as Wei and Qi, which could be prescribed Yin Qiao San, Sang Ju Yin or Ma Xing Gan Shi Tang. In the critical stage of the disease which could be defined as Ying and Xue, we could use An Gong Niu Huang Wan, Sheng Mai San or Xi Jiao Di Huang Tang for adjuvant therapy. It is expected that the cooperation between TCM and WM will help to improve the therapeutic effect and the prognosis of COVID-19.